Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
J Gastroenterol Hepatol. 2022 Nov;37(11):2083-2090. doi: 10.1111/jgh.15967. Epub 2022 Aug 3.
EB-RFA with self-expandable metal stent (SEMS) may improve the stent patency and patient survival in malignant extrahepatic biliary obstruction. However, there are few studies on the role of EB-RFA for malignant hilar obstruction (MHO). This study aimed to assess the feasibility, efficacy, and safety of EB-RFA for MHO.
We retrospectively compared the stent patency and survival among 79 consecutive patients with MHO who underwent bilateral uncovered SEMS placement without and with EB-RFA between April 2016 and January 2020.
Fifty-one patients (64.6%) underwent SEMS placement alone (stent alone group), whereas 28 (35.4%) underwent SEMS placement after EB-RFA (RFA-stent group). All procedures were successful (100%). During follow-up, stent occlusion occurred in 59 patients (74.7%), of which 40 (78.4%) and 19 (67.9%) were in the stent alone and RFA-stent groups, respectively. There was no difference in stent patency (192 ± 39.2 days vs 140 ± 53.7 days, P = 0.41) and survival (311 ± 24.7 days vs 311 ± 46.9 days, P = 0.73) between the stent alone and RFA-stent groups. Multivariate cox analysis showed a hazard ratio (HR) of 2.892 (1.579-5.294, P = 0.001) for stent occlusion in patients who did not receive chemotherapy. EB-RFA had no significant effect on stent occlusion (HR, 1.150, 0.644-2.053, P = 0.636).
SEMS placement after EB-RFA in MHO was not associated with improvement in the stent patency or patient survival. Further prospective randomized studies are necessary to establish the effectiveness of EB-RFA with stents in MHO.
在恶性肝外胆管梗阻中，使用自膨式金属支架（SEMS）的内镜下射频消融（EB-RFA）可能会改善支架通畅性和患者生存率。然而，关于恶性肝门部梗阻（MHO）的 EB-RFA 作用的研究较少。本研究旨在评估 EB-RFA 治疗 MHO 的可行性、疗效和安全性。
我们回顾性比较了 2016 年 4 月至 2020 年 1 月期间，79 例 MHO 患者分别接受双侧未覆盖 SEMS 放置和 SEMS 放置联合 EB-RFA 的支架通畅率和生存情况。
51 例患者（64.6%）接受单纯 SEMS 放置（支架单独组），28 例患者（35.4%）接受 SEMS 放置后 EB-RFA（RFA-支架组）。所有手术均成功（100%）。随访期间，59 例患者（74.7%）发生支架闭塞，其中支架单独组 40 例（78.4%）和 RFA-支架组 19 例（67.9%）。支架通畅率（192±39.2 天 vs 140±53.7 天，P=0.41）和生存率（311±24.7 天 vs 311±46.9 天，P=0.73）在支架单独组和 RFA-支架组之间无差异。多因素 Cox 分析显示，未接受化疗的患者支架闭塞的风险比（HR）为 2.892（1.579-5.294，P=0.001）。EB-RFA 对支架闭塞无显著影响（HR，1.150，0.644-2.053，P=0.636）。
MHO 患者行 SEMS 放置联合 EB-RFA 并不改善支架通畅率或患者生存率。需要进一步前瞻性随机研究来确定 MHO 中 SEMS 联合 EB-RFA 的有效性。
